Page 118 - Human Lyme Neuroborreliosis

102 David S. Younger

Table 1. Suggested Treatment Based On Neurological Syndrome1

Meningitis: IV ceftriaxone or cefotaxime or penicillin G
Encephalomyelitis: IV ceftriaxone or cefotaxime or penicillin G
Encephalopathy: treat as encephalomyelitis if CSF abnormal; IV or PO antibiotics
if CSF normal
Radiculopathy, neuropathy, MNM, cranial neuritis: Oral antibiotics or IV if
treatment failure or severe
1Adapted from reference 18.

Table 2. Suggested Treatment Regimens1

First Line
Oral adult regimen: doxycycline 100-200 mg bid
Parenteral adult regimen: ceftriaxone 2 g IV daily
Oral pediatric regimen (in children > or = 8 years of age): doxycycline 4-8
mg/kg/d in divided doses, max 200 mg/dose
Parenteral pediatric regimen: ceftriaxone 50-75 mg/kg/d in 1 dose; max 2 g

Second Line
Oral adult regimen (when doxycycline contraindicated): amoxicillin 500 mg TID
Parenteral adult regimen: cefotaxime 2 g IV Q8H
Oral pediatric regimen (when doxycycline contraindicated): amoxicillin 50
mg/kg/d in 3 divided doses; max 500 mg/dose
Parenteral pediatric regimen: cefotaxime 150-200 mg/kg/d in 3- 4 divided doses;
max 6 g/day

Third Line
Oral adult regimen (when doxycycline contraindicated): cefuroxime axetil 500 mg
BID
Parenteral adult regimen: penicillin G 18-24 MU/d, divided doses Q4H

Oral pediatric regimen (when doxycycline contraindicated): cefuroxine axetil 30
mg/kg/d in 2 divided doses; max 500 mg/dose
Parenteral pediatric regimen: penicillin G 200-400U/kg/d in divided doses Q4H;
max 18-24 MU/day
1Adapted from reference 18.

Immunological Aspects

To further complicate management of disseminated Lyme disease has
been the recognition that the immune system play an important role is disease

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